Fertility—myth and reality

Abstract

While life expectancy over the last century has increased from about 50 to over 80 years, the fertile lifespan has not, and reproductive aging inevitably leads to reproductive senescence and menopause. Over the past half century there has been a trend towards delayed motherhood, with a mean age at first pregnancy moving towards 30 years. Postponing reproduction can increase the chance of a woman remaining involuntarily childless as well as an increase in pregnancy complications in those that do achieve a pregnancy at advanced maternal age. Despite the well-documented age dependent decrease in fecundity, reproductive-aged women frequently underestimate the decline in fertility and measures to increase fertility awareness are called for. Infertility affects about one in six couples. Prompt diagnosis and therapy of impaired fertility are important because chances for a live birth continue to decrease with aging. The success rates of assisted reproductive technologies are high but also age dependent. Oocyte donation might be an option for women nearing the end of natural fertility. Several options to preserve fertility are now available for women facing imminent ovarian failure, for example as a result of gonadotoxic therapy.